Detection of Ectopic Beats in the Electrocardiogram Using an Auto-Associative Neural Network

Abnormal rhythms of the heart are often preceded by the occurrence of ectopic beats. These are difficult to detect as their shape is not very different from that of a normal QRS complex, the main feature in the electrocardiogram. We show how an auto-asociative multi-layer perceptron can be trained to detect normal beats only, so that the subtle abnormalities in shape of ectopic beats become clearly identifiable. This is a generic detector of abnormal beats (i.e. beats whose morphology is different from that of a normal beat) and we use ventricular ectopic beats to illustrate the performance of the algorithm. We also propose a new parameter, the variance ratio, to monitor the progress of learning in an auto-associative network.     

Stage IA1 cervical adenocarcinoma: definition and treatment

OBJECTIVE: To propose a definition for stage IA1 cervical adenocarcinoma, based on the International Federation of Gynecology and Obstetrics (FIGO) staging system, and to determine if patients meeting criteria might be candidates for conservative surgery. METHODS: Two hundred women were diagnosed with early-stage cervical adenocarcinoma from 1982 to 1996. Histopathologic sections were reviewed by a gynecologic pathologist. Medical records were reviewed, and patients included in this study had microscopically identifiable lesions, up to 3 mm invasive depth, up to 7 mm tumor width, and negative margins if cone biopsy was performed. RESULTS: Twenty-one patients with microinvasive adenocarcinoma met criteria for FIGO stage IA1 carcinoma of the cervix. The median (range) follow-up was 76 (30-172) months and median (range) patient age was 38 (24-75) years. Definitive treatment included type II or III radical hysterectomy in 16 cases, simple abdominal or vaginal hysterectomy in four cases, and loop electrosurgical excision procedure in one case; one patient received adjuvant pelvic radiation. The histologic subtypes were endocervical adenocarcinoma in 18 cases, adenosquamous carcinoma in two cases, and clear-cell adenocarcinoma in one case. There was no evidence of parametrial invasion or lymph node metastases in any patient who had radical surgery, and there were no disease recurrences. CONCLUSION: Patients with microinvasive adenocarcinoma who met criteria for FIGO stage IA1 cervical carcinoma had disease limited to the cervix, and conservative surgery, such as cone biopsy or simple hysterectomy, might offer them definitive treatment.     

Is it PAO-GAO competition or metabolic shift in EBPR system? Evidence from an experimental study

Reduced EBPR performance in full and bench-scale EBPR studies was linked to the proliferation of GAOs but often time with the lack of any evidence. In this study, a detailed enzymatic study was coupled with batch tests and electron microscopy results for a realistic explanation. The results eliminated the possibility of population shift from PAO to GAO or other non-PAO due to the short batch test period provided which would not allow a population shift and further justified with the electron microscopy results. The results indicate that glycogen serves not only as source of reducing power for PHA production but also serves as an alternative energy source when the poly-P pool of the PAOs is depleted. Slow generation of ATP via glycolytic pathway at 5 degrees C cannot satisfy energy requirements of EBPR cells to complete several cell functions including acetate uptake and PHA storage. However, the glycolytic pathway is efficiently operable at warm temperatures (> 20 degrees C). The reduced performance of enhanced EBPR facilities operated at warm temperature may not be a result of GAO proliferation; instead it may be related the efficient use of the glycolytic pathway by PAOs which results in more glycogen storage and less P uptake, thereby reducing the EBPR performance.     

Capillary Barrier Effect from Underlying Coarser Soil Layer

Infiltration tests were conducted on soil columns of silty sand over pea gravel, concrete sand over pea gravel, and silty sand over concrete sand to investigate the capillary barrier effect of an underlying coarser soil layer. Water movement across the interface occurred when the suction head at the interface reached the breakthrough head of the coarser lower soil layer, defined as the suction head at which the coarser layer first became conductive, regardless of infiltration rate or the properties of the overlying finer soil layer. Thus, the coarser lower soil layer controlled breakthrough in this study. After infiltration was terminated, the suction head near the interface increased above the breakthrough head and the barrier was restored. The breakthrough head did not change substantially after eight test cycles of breakthrough and restoration for a capillary barrier with a pea gravel as the coarser lower soil layer. The barrier formed with the concrete sand as the coarser layer permitted breakthrough at a greater suction head than did the barrier with the pea gravel, indicating that the more uniform and coarse the lower soil layer is, the more effective the capillary barrier.     

Deletion of cell division cycle 2-like 1 gene locus on 1p36 in non-Hodgkin lymphoma

Our laboratories have documented a significantly high occurrence of chromosome 1p36 rearrangements in non-Hodgkin lymphoma (NHL). The cell division cycle 2-like 1(CDC2L1) (also known as TP58 or PITSLRE) gene, a protein kinase implicated in apoptotic signaling, is located at the very distal region of chromosome 1p36 and is likely to be disrupted by structural rearrangements involving 1p36. To determine the molecular consequences of the recurrent involvement of the 1p36 region, we examined metaphases containing 1p36 abnormalities from 31 specimens derived from 26 patients for the possible deletion of CDC2L1 by fluorescence in situ hybridization (FISH) using the TP58clk-1 DNA probe. Twenty-three cases exhibited the loss of CDC2L1 from the abnormal chromosome 1. In 2 of 26 cases, the gene locus was translocated to the partner chromosome, and in four specimens, all derived from one case, CDC2L1 was not deleted. This pilot investigation suggests that 1p36 rearrangements, and consequently the loss of the CDC2L1 gene locus, is important in NHL. This work also opens avenues for further molecular studies and prognostic correlations.     

Hepatocyte growth factor-stimulated renal tubular mitogenesis: effects on expression of c-myc, c-fos, c-met, VEGF and the VHL tumour-suppressor and related genes

Hepatocyte growth factor (HGF/SF) is a potent renal proximal tubular cell (PTEC) mitogen involved in renal development. HGF/SF is the functional ligand for the c-met proto-oncogene, and germline c-met mutations are associated with familial papillary renal cell carcinoma. Somatic von Hippel-Lindau disease tumour-suppressor gene (VHL) mutations are frequently detected in sporadic clear cell renal cell carcinomas (RCC), and germline VHL mutations are the commonest cause of familial clear cell RCC. pVHL binds to the positive regulatory components of the trimeric elongin (SIII) complex (elongins B and C) and has been observed to deregulate expression of the vascular endothelial growth factor (VEGF) gene. HGF/SF has similarly been reported to up-regulate expression of the VEGF gene in non-renal experimental systems. To investigate the mechanism of HGF/SF action in PTECs and, specifically, to examine potential interactions between the HGF/c-met and the VHL-mediated pathways for renal tubular growth control, we have isolated untransformed PTECs from normal kidneys, developed conditions for their culture in vitro and used these cells to investigate changes in mRNA levels of the VHL, elongin A, B and C, VEGF, c-myc, c-fos and c-met genes after HGF/SF exposure. Significant elevations in the mRNA levels of VEGF, c-myc, c-fos, c-met and elongins A, B and C, but not VHL, were detected after HGF/SF stimulation of human PTECs (P < 0.02), with a consistent order of peak levels observed over successive replicates (c-fos at 1 h, VEGF at 2-4 h, c-myc, at 4 h, followed by c-met and all three elongin subunits at 8 h). This study highlights the spectrum of changes in gene expression observed in PTECs after HGF/SF stimulation and has identified possible candidate mediators of the HGF/SF-induced mitogenic response. Our evidence would suggest that the changes in PTEC VEGF expression induced by HGF/SF are mediated by a VHL-independent pathway.     

Cytochrome P4502C9: an enzyme of major importance in human drug metabolism

Accumulating evidence indicates that CYP2C9 ranks amongst the most important drug metabolizing enzymes in humans. Substrates for CYP2C9 include fluoxetine, losartan, phenytoin, tolbutamide, torsemide, S-warfarin, and numerous NSAIDs. CYP2C9 activity in vivo is inducible by rifampicin. Evidence suggests that CYP2C9 substrates may also be induced variably by carbamazepine, ethanol and phenobarbitone. Apart from the mutual competitive inhibition which may occur between alternate substrates, numerous other drugs have been shown to inhibit CYP2C9 activity in vivo and/or in vitro. Clinically significant inhibition may occur with coadministration of amiodarone, fluconazole, phenylbutazone, sulphinpyrazone, sulphaphenazole and certain other sulphonamides. Polymorphisms in the coding region of the CYP2C9 gene produce variants at amino acid residues 144 (Arg144Cys) and 359 (Ile359Leu) of the CYP2C9 protein. Individuals homozygous for Leu359 have markedly diminished metabolic capacities for most CYP2C9 substrates, although the frequency of this allele is relatively low. Consistent with the modulation of enzyme activity by genetic and other factors, wide interindividual variability occurs in the elimination and/or dosage requirements of prototypic CYP2C9 substrates. Individualisation of dose is essential for those CYP2C9 substrates with a narrow therapeutic index.     

Quality assurance of psychiatric consultations in somatic hospitals

Research has shown great variety in the clinical practice of consultation-liaison psychiatry in and between different countries. This paper presents the Norwegian experiences from a European collaborative study of quality management in consultation-liaison psychiatry. We describe a dynamic model for total quality management based on regular registration of some clinical data and the subsequent feed-back on changes of these. We discuss our experiences with this model and obstacles met in everyday work. Finally we point to different ways of implementing this method on a broader base in consultation-liaison psychiatry.